Page 93 - Preventing pertussis in early infancy - Visser
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Organisational determinants5
Vaccinations on the ward (easy and convenient)
Vaccination in response to local incident Flexible appointment times
Additional doctor’s appointment (barrier)
Missed opportunity (barrier) Vaccination not offered
No time
Inadequate organisation
++ ++
- ++ ++ ++
++ +
++ + ++ ++
+ + ++ ++
LR/ UPD (Paranthaman et al. 2016)
LR (Paranthaman et al. 2016)
LR/UPD (Paranthaman et al. 2016)
LR (Harrison et al. 2016)
LR (Ryser et al. 2015) LR (Taddei et al. 2014)
LR (Mir et al. 2012) LR/UPD (Mir et al. 2012)
1. Based on Visser et al. (2017), data stated in this column refers to paediatric nurses, unless indicated otherwise. 2. - = not changeable/ relevant; 0 = maybe changeable/ relevant; + = change is theoretically possible/ theoretically relevant; ++ = evidence for change/relevance has been found in empirical literature; OR = odds ratio, represents
the odds of a positive intention (i.e. >5 on 7 point Likert scale) given the occurrence of the determinant, compared to absence of that determinant; β = regression coefficient, represents the mean change in intention for one step increase of the determinant on the 7 point Likert scale; LR = based on literature review [references]; UPD = unpublished data.
3. Based on Visser et al. (2017) data for this determinant refers to midwives.
4. Based on Visser et al. (2017) data for this determinant refers to maternity assistants.
5. These organisational determinants form input for the ecological approach of IM. This means that each
determinant can be translated into an environmental level outcome for which an environmental agent is responsible and matrices of change objectives can be formulated. This is outside the scope of this article.
IM Step 2: Programme outcomes and objectives, Logic model of change
The construction of a logic model of change is central for step 2 of IM. The first task was to translate the causes of nosocomial pertussis in infants into problem reducing or health promoting behaviour, such as vaccination of HCWs. This is illustrated in Figure 2.
Subsequently, we used discussion in the research group (OV, JH, MH, RR, KV), data from our previous studies (Visser et al. 2016, Visser et al. 2017) and literature review (Kok et al. 2011) to formulate specific sub-behaviour that HCWs have to perform in order to achieve the programme goal, by answering the question “who has to do what in order to promote the pertussis vaccination among HCWs?”. The sub-behaviour aspects are called Performance Objectives (POs) and were identified as follows: 1) HCWs evaluate their own risk situation for pertussis, concerning both their risk to contract and to transmit pertussis; 2) HCWs evaluate the pertussis vaccination in relation to their personal values; 3) HCWs take deliberate decisions to accept a pertussis vaccination; 4) HCWs plan to implement their choice and find out when and where the vaccination is provided; and 5) HCWs get vaccinated.
Next, we selected the most relevant and changeable determinants for each PO (see also Table 1). Determinants that have a minor influence on the performance objective, based on either evidence or theory, are unlikely to be important targets for an intervention. At the same time, determinants that have a large influence on the performance objective, but are impossible to change (again, either based on evidence or on theory) also disqualify
Intervention Mapping
Intervention Mapping
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